The All-Seeing Nurse

"I've seen it all."

I have heard this statement countless times from nurses. They state it as fact, with pride, and at times with arrogance. I completely disagree with any nurse that makes this proclamation. There are so many diseases and possible traumas we have never heard of that we can't even comprehend the vastness of what we have not seen. We have never seen Yellow Fever wipe out an entire city, like it did to Memphis in the 1800s. How many nurses have seen Chikungunya (Chik-un-what?)? Although Ebola is now a familiar word, only a handful of nurses have actually seen it in action.

After watching the documentary "Triage: Dr. James Orbinski's Humanitarian Dilemma," I realized that the nursing I do and all I've seen could fit in a doll's coat pocket, with room to spare. This documentary tells the story of a Canadian physician working in Rwanda during the genocide of the Tutsi by the Huku.

One of his many stories stands out. A woman was brought into his overpopulated, understaffed facility for treatment. She had been raped, tortured, and beaten. Her face had been slashed beyond recognition. Before the Huku left her for dead they smeared their semen over her withered body. Upon seeing her, Dr. Orbinski turned his back to her and vomited; not because of how she looked, but because he was repulsed that any human could do this to another human. Not only could he not save this woman, something in his human spirit broke that day. He had seen the worst in human beings.

There's an extreme dichotomy in Dr. Orbinski's story. While hearing about the grotesque things he saw on a medical and human level, we see the beauty of his spirit, his perseverance to help a nation in turmoil, putting his own life at risk.

It is all relative, what we deem as "crude" and "beautiful". As a nurse, you are bound to encounter both.

Me, after work, at 0800.

I See Disrespect in Your Crudeness

I was the break relief nurse for the night. A patient in 406B called. She needed to go to the bathroom. She was taking off the nasal cannula that supplied her with oxygen as she scooted herself to the edge of the bed. She was already short of breath.

"Keep your oxygen on," I said.

"No, I can go without it."

"You need to keep the oxygen on. The tubing will reach," I reassured her. Seeing how she was already struggling with minimal activity, walking to the bathroom was a risk.

She ignored me and began walking unsteadily to the bathroom. I held her gown tight around her waist for support and guidance. She brushed my hand away.

"Close the door, give me privacy."

"I can't leave you alone, you're not stable. You need oxygen," I said attempting to give her the nasal cannula.

"Close the door. I said I don't want it! Why can't you get it through your head?" she asked with scraps of air that she could bring forth.

"Because after you fall to the floor I don't want to have to be the one to save you!" I snapped back.

But it's more than that - it's my license on the line and management despises fall. Nurses get questioned and reprimanded over falls, not deaths, just falls. Safety first is our motto. If she falls, I have to report it. The first question that would be asked: Why did you leave her alone and without oxygen? That's a question that has no correct answer. So I refused to leave.

Despite her labored breathing, deep wheezes, and body tilting forward, she sneered at me as she sat down on the toilet seat. I stood in front of her to hold her shoulders up. She reached down between her legs and with one hand pulled out her tampon and swung it like a pendulum millimeters from my face. It was so close to me, I could smell it and feel her inner body heat coming off of it. She was completely out of breath; she let the tampon do the talking for her. When I stepped back in horror, I saw her sneer turn to a satisfied smirk of triumph over me.

I was disgusted. My dismay was greater than the fear of losing my license. So, I left her sitting on the toilet with her lungs on the verge of collapse. I walked straight to another nurse and said "I hate this job!"

"She what?!?" asked the nurse when I told him what she did. He said he would help her back to bed and for me to stay out of the room.

I get it. She's frustrated. She can't breathe. COPD (chronic obstructive pulmonary disease) exacerbation sucks. I'm here. Let me help you. Patient, are you not in the hospital to be helped? If not, go home!

It wasn't the sight or smell of a dirty tampon; I'm accustomed to blood and every other bodily fluid. It was the crudeness of her act. There's a difference in helping a woman during her menses and a woman intentionally pulling out a dirty tampon and swinging it in the face of another woman. It is an extreme form of disrespect. It's as low as you can go. Curse me out, call me the C-word or the B-word, or any combination of letters in the alphabet! The tampon incident made me not care about her or her condition. Yet, if she had been struck by lightening at that moment, I, and many others, would still have provided chest compressions and oxygen to bring her back - so she could insult me, and many others, once again.

To her credit, hours later she did call me back to her room to apologize. I stood a safe distance from her bed and listened to her pathetic apology. I kept my facial expression stoic. "Anything else you need?" I asked. She said she didn't. I walked out without accepting her apology.

Is it in our policy or license that we must tolerate abuse? Most days that's how it feels, like I'm in a verbally abusive relationship with complete strangers, wherein I beg them to let me help them. Something is terribly wrong with this system.

Namaste, I See You

It's all about balance for the tightrope walker on a thin wire. To maintain balance he/she must be focused. To help keep focus they zero their eyes in on a specific spot far ahead of them. Nothing can tear their gaze away. The gaze is a crucial component to their balance. Their life is dependent on it.

***

Michael was a seventeen-year-old brought in after he crashed his truck. He had devastating injuries: a traumatic brain injury and countless broken bones. The majority of the day, his eyes remained open, his gaze fixed. His Glasgow Coma Scale score was low; he was not expected to ever "come out of it."

He had a craniectomy to allow his swollen brain some space. The scalp, that delicately covered his brain just beneath the surface, would remain concave until it was safe enough to replace that portion of his skull. We kept a hard helmet in his closet for those days he would be moved from bed to cardiac chair. He also had a colostomy bag for pooping, a gastric tube for feeding, a tracheostomy for breathing, and devotedly, a family that was not going to give up.

His parents relied on faith and educating themselves on their son's condition. They scoured the internet, wherein they researched every available option for their son to get better. They demanded that we follow their specific instructions: Reposition him hourly, change him from the soft heel protector to the hard Prafo Boots every two hours, do passive range of motion exercise when you touch him, and watch for any clue of him coming to.

At first, I too, thought it was hopeless. Michael would spike temps, crazy heart rates and irregular breathing. It seemed at any given moment he would die. I was so scared that he would die on my watch. He lost so much weight he looked like a nicely laid out skeleton dressed in a hospital gown. However, the months passed, and every now and then I felt he was tracking - following me with his eyes ever so briefly. I could of sworn we made eye contact on occasion. I diligently charted what I did and what I saw. I told a morning shift nurse my belief - he follows me with his eyes. She said his parents claimed that Michael wiggled his toe when they asked him to and that he they'd also seen him tracking. However, the trauma doctors said it was not possible, that the family, and now the nurses, were emotionally attached to Michael and imagining this progress. At times, I would get in Michael's face, in his line of vision, and speak to him. No response, no evidence of any signal received by his tender cerebrum.

A few months passed. One night, another nurse and I were cleaning him. I spoke to him. I said "Look at me." Nothing. As we log rolled him toward me I said it again. We locked eyes for a split second. "You have such beautiful eyes, Michael," I said. And then...he blushed.

I screamed, so did the other nurse. I did my "happy dance" at his bedside. I repeated over and over, "He blushed! He blushed! He's there. He's inside! Michael, I saw that!" Michael had blushed, just as any shy, teenage boy would have if complimented by an older woman.

Blushing is an involuntary reaction to being self-conscious. Self-conscious. Conscious. I had no doubt now. I had not imagined Michael tracking. We had met eye to eye. And for the first time, I truly understood the meaning of a word I use in my Buddhist practice, Namaste.

Namaste: The Divine in me honors the Divine in you. I honor the light, love, beauty, truth and kindness that is within you because it is also within me. In sharing these things there is no distance and no difference between us. We are the same. We are one.

In that moment we were one. I knew it, I saw it, I felt it. It remains the single most gratifying moment in my nursing career. If I could feel this way once a week at work, I'd be a workaholic.

Michael went back to his gaze. I wondered what he thought about. I wondered what would become of him when one night I went to work and found his room occupied by another trauma patient. Michael had been sent to a rehabilitation facility that specialized in traumatic brain injuries.

And then one day... he walked back in with his mother. It happened on day shift, so I missed seeing him stand upright, saying "Thank You" to nurses that looked "familiar" to him but he did not know. He had made a miraculous recovery. His mother filled him in on his long hospital stay and the nurses that helped him. A day shift nurse told me that all the nurses cried as he went to each of them for a hug, for a few words of gratitude. I cried hearing the story. I also cried because I wanted to see Michael, the boy who blushed while "comatose".

***

The wire is thin. Getting across is not a sprint and it's more than a marathon. It takes time, left foot, right foot, left foot, right foot. The hip joints must be aligned, precise; the spine and neck elongated, yet relaxed. And the gaze, the prerequisite & the constant gaze, must be mastered. It's the tool that will put everything into balance.

The doctors had mistaken Michael's gaze as irreparable brain damage. His brain, even swollen, knew it had a lot of work to do: reduce its own swelling, balance out electrolytes, infections, broken bones, twisted muscles and torn ligaments. It had no other option but to shut Michael down, to place him into a deep involuntary gaze. His life was dependent on it. He wasn't just lying there doing nothing. All along he was walking a tightrope.

And he made it across.

***

My stories don't compare to Dr. Orbinksi's. If I'd seen what was dragged into his clinic, my brain would have to place me into a gaze to process and balance it all out. Sure, there are diseases and traumas I'd be curious to see and be involved with, but I like knowing I haven't seen it all. It leaves me with a tinge of excitement and trepidation of the unknown, of what I may see in the years to come.

Sight. Gaze. See. View.

This is Part 3 of the Series "The Senses of Night Shift". You may read Part 1: Sound (published 7/26) and Part 2: Taste/Smell (published 7/31) under the "Blog" tab.